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Optimal timing of cholecystectomy in children with gallstone pancreatitis
Faidah Badru1, Saurabh Saxena1, Robert Breeden2
1Department of Pediatric Surgery, Cardinal Glennon Children's Hospital, St. Louis, Missouri.
Insights
Pediatric gallstone pancreatitis recurrence is reduced with timely cholecystectomy. Performing surgery during the initial hospital stay for gallstone pancreatitis prevents pancreatitis recurrence and readmissions.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Biliary Tract Disease
Background:
- Gallstone pancreatitis recurrence rates in pediatric patients awaiting cholecystectomy are not well-documented.
- Acute gallstone pancreatitis requires prompt management to prevent complications.
Purpose of the Study:
- To evaluate the recurrence rate of pancreatitis in pediatric patients after acute gallstone pancreatitis.
- To determine the impact of cholecystectomy timing on pancreatitis recurrence.
Main Methods:
- Retrospective chart review of pediatric patients (2007-2015) with gallstone pancreatitis.
- Patients categorized into five groups based on cholecystectomy timing: during index admission, within 2 weeks, 2-6 weeks, >6 weeks post-discharge, and no surgery.
- Pancreatitis recurrence rates were calculated for each group.
Main Results:
- Of 48 patients, 19 underwent cholecystectomy during the index admission with zero recurrence.
- Among patients not operated on during index admission (n=29), 31% experienced pancreatitis recurrence or readmission.
- Recurrence rates varied by timing: 25% (2-week group), 37.5% (2-6 week group), 60% (>6 week group), and 12.5% (no surgery group).
Conclusions:
- Cholecystectomy during the index admission for gallstone pancreatitis is associated with no recurrence or readmission.
- Early cholecystectomy following gallstone pancreatitis resolution during the index admission is recommended for pediatric patients.
Background:
Little data exist regarding the recurrence of pancreatitis in pediatric patients with gallstone pancreatitis awaiting cholecystectomy. This study evaluates the recurrence rate of pancreatitis after acute gallstone pancreatitis based on the timing of cholecystectomy in pediatric patients.
Materials And Methods:
A retrospective chart review of all patients admitted with gallstone pancreatitis from 2007 to 2015 was performed. Children were divided into the following five groups. Group 1 had surgery during the index admission. Group 2 had surgery within 2 wk of discharge. Group 3 had surgery between 2 and 6 wk postdischarge. Group 4 had surgery 6 wk after discharge, and group 5 patients had no surgery. The recurrence rates of pancreatitis were calculated for all groups.
Results:
Forty-eight patients with gallstone pancreatitis were identified in this study. The 19 patients in group 1 had no recurrence of their pancreatitis. Of the remaining 29 patients, nine (31%) had recurrence of pancreatitis or required readmission for abdominal pain prior to their cholecystectomy. In group 2, two of the eight patients (25%) had recurrent pancreatitis. In group 3, three of eight patients (37.5%) developed recurrent pancreatitis. In group 4, three of five patients (60%), and in group 5, one of eight. No children in group 5 had demonstrable gallstones at presentation, only sludge in their gallbladder.
Conclusions:
Cholecystectomy during the index admission is associated with no recurrence or readmission for pancreatitis. Therefore, we recommend that cholecystectomy be performed after resolution of an episode of gallstone pancreatitis during index admission.
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